Don't Let Health Reform Gut State Health Laws

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Message:

Subject: Don't Let Health Reform Gut State Health Laws
Senate Majority Leader Harry Reid:

United States Senate

Hart Senate Office Building, Room 522

Washington, DC 20510

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cc: President Obama, U.S. Sentate, U.S. House of Representatives

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Dear Senator Reid:

On behalf of Consumer Watchdog, I am writing to urge you to oppose provisions contained in the Senate Finance health care reform legislation that would pre-empt state health benefit mandate laws, replace them with less protective federal "minimum" standards and undermine state enforcement efforts. Under the terms of the Finance bill, millions of Americans could lose insurance coverage of important medical treatments and services such as AIDS/HIV testing, reconstructive surgery, home health care services, and child delivery and mastectomy minimum hospital stays.

Read the Los Angeles Times front page article at: http://www.consumerwatchdog.org/patients/articles/?storyId=31200

Instead, the final Senate health reform bill should be modeled on existing federal health care laws which provide for a federal-state partnership rather than federal pre-emption of more protective state standards. Minimum federal standards should set a floor, not a ceiling, on state health care protections.

Seventeen states with more than fifty health benefit mandates in state law have the most to lose under pre-emption provisions of the Finance legislation. Those states, including your home state of Nevada, represent 54% of the U.S. population: California, Colorado, Connecticut, Florida, Louisiana, Massachusetts, Maryland, Maine, Minnesota, New Mexico, Nevada, New York, Pennsylvania, Rhode Island, Texas, Virginia and Washington.

Under the provisions of the Finance bill, approximately 87 million Americans, who are currently enrolled in individual policies or receive health coverage from non-self insured employers, are at risk of being sold junk insurance that does not protect them when they get sick.

The Senate Finance committee bill would allow health insurers to sell "Nationwide" insurance policies that override state health benefit mandates approved by state legislatures with new, less protective provisions designed by a private organization, the National Association of Insurance Commissioners (NAIC). In developing the federal guidelines, the NAIC, heavily influenced by health insurance companies, would merely take "into account how each benefit is offered in a majority of states." Therefore, many treatment mandates appearing in fewer than 26 states would apparently not be covered under the Nationwide policies. Patients purchasing Nationwide policies would likely be unaware that their insurance was riddled with holes until they needed to use it.

Another provision of the Finance bill would allow insurers to form "interstate compacts" to sell policies across state lines while being subject only to the health benefit mandate laws of the state in which the insurance policy is "written or issued." Insurers would certainly choose to be regulated by the weakest state. A similar provision was inserted in the U.S. House of Representative bill, H.R. 3962, shortly before it was voted on.

Provisions in the bill allowing states to "opt-out" of permitting Nationwide plans and "opt-in" to interstate compacts offer little protection. The 1,000 health insurance lobbyists estimated to be working the federal health reform bill, and the industry's unlimited capacity to buy votes with campaign contributions, would be marshaled to advance the insurers' interest at the state level.

Insurers claim that eliminating these patient protections is essential to reducing costs in the system. However, the data suggests otherwise. The Congressional Budget Office found that five of the state coverage mandates considered by insurers to be the most expensive have in fact only a marginal impact on premiums, ranging from 0.28 to 1.15 percent.[1] Massachusetts, which has among the strongest state mandates, calculated the total net cost on premiums to be only 3 percent to 4 percent.[2] Compare that to the 25 percent to 27 percent of premiums that goes to insurer overhead and profit.[3] What insurers are not saying is that state coverage mandates that ensure access to basic health care needs are necessary to prevent and manage disease, or to treat it before it becomes severe and more expensive to care for.

Both the "Nationwide plans" and "state compact" pre-emption scenarios are similar to a failed 2006 bill, S.1955, by Sen. Enzi (R-Wyo.) who championed President Bush's health reform agenda. Pre-emption of state health care laws was a bad idea in 2006, and it is a bad idea now.

States have traditionally been the laboratories of innovation in health care and insurance reform. Instead of taking away regulatory power from the states, Congress should recognize and promote successful state insurance regulation like California's landmark insurance regulation initiative, Proposition 103. Proposition 103 has resulted in $61.8 billion in savings to California automobile drivers. Read more about that successful state reform and its application to health insurance at: http://www.consumerwatchdog.org/patients/articles/?storyId=30813.

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1 Congressional Budget Office, Increasing Small-Firm Health Insurance Coverage Through Association Health Plans and HealthMarts 21 (January 2000).

2 Massachusetts Division of Health Care Finance and Policy, Comprehensive Review of Mandated Benefits in Massachusetts: Report to the Legislature 4 (July 2008).

3 Cathy Schoen, et al., "Building Blocks for Reform: Achieving Universal Coverage With Private and Public Group Health Insurance," Health Affairs, Volume 27, No. 3, May/June 2008, p. 647. A public option based on Medicare is expected to provide premiums more than 30 percent lower than private market premiums as a result, in part, of Medicare's lower administrative costs. Karen Davis et. al., "The Building Blocks of Health Reform: Achieving Universal Coverage and Health System Savings," CommonWealth Fund Issue Brief, p. 2 (May 2008).
Sincerely,

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Barack Obama, The President Of The United States


Daniel K. Akaka, U.S. Senator, HI, Democratic Party


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Christopher Lee, U.S. Representative, NY-26, Republican Party


Sander M. Levin, U.S. Representative, MI-12, Democratic Party


Jerry Lewis, U.S. Representative, CA-41, Republican Party


John Lewis, U.S. Representative, GA-5, Democratic Party


John E. Linder, U.S. Representative, GA-7, Republican Party


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David Loebsack, U.S. Representative, IA-2, Democratic Party


Zoe Lofgren, U.S. Representative, CA-16, Democratic Party


Nita M. Lowey, U.S. Representative, NY-18, Democratic Party


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Blaine Luetkemeyer, U.S. Representative, MO-9, Republican Party


Ben R. Lujan, U.S. Representative, NM-3, Democratic Party


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Connie Mack, U.S. Representative, FL-14, Republican Party


Dan Maffei, U.S. Representative, NY-25, Democratic Party


Carolyn B. Maloney, U.S. Representative, NY-14, Democratic Party


Donald A. Manzullo, U.S. Representative, IL-16, Republican Party


Kenny Marchant, U.S. Representative, TX-24, Republican Party


Betsy Markey, U.S. Representative, CO-4, Democratic Party


Edward J. Markey, U.S. Representative, MA-7, Democratic Party


Jim C. Marshall, U.S. Representative, GA-8, Democratic Party


Eric Massa, U.S. Representative, NY-29, Democratic Party


Jim Matheson, U.S. Representative, UT-2, Democratic Party


Doris Matsui, U.S. Representative, CA-5, Democratic Party


Carolyn McCarthy, U.S. Representative, NY-4, Democratic Party


Kevin McCarthy, U.S. Representative, CA-22, Republican Party


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Tom McClintock, U.S. Representative, CA-4, Republican Party


Betty McCollum, U.S. Representative, MN-4, Democratic Party


Thaddeus G. McCotter, U.S. Representative, MI-11, Republican Party


Jim McDermott, U.S. Representative, WA-7, Democratic Party


James P. McGovern, U.S. Representative, MA-3, Democratic Party


Patrick T. McHenry, U.S. Representative, NC-10, Republican Party


Mike McIntyre, U.S. Representative, NC-7, Democratic Party


Buck P. McKeon, U.S. Representative, CA-25, Republican Party


Michael E. McMahon, U.S. Representative, NY-13, Democratic Party


Cathy McMorris Rodgers, U.S. Representative, WA-5, Republican Party


Jerry McNerney, U.S. Representative, CA-11, Democratic Party


Kendrick B. Meek, U.S. Representative, FL-17, Democratic Party


Gregory W. Meeks, U.S. Representative, NY-6, Democratic Party


Charlie R. Melancon, U.S. Representative, LA-3, Democratic Party


John L. Mica, U.S. Representative, FL-7, Republican Party


Michael H. Michaud, U.S. Representative, ME-2, Democratic Party


Brad Miller, U.S. Representative, NC-13, Democratic Party


Candice S. Miller, U.S. Representative, MI-10, Republican Party


Gary G. Miller, U.S. Representative, CA-42, Republican Party


George Miller, U.S. Representative, CA-7, Democratic Party


Jeff B. Miller, U.S. Representative, FL-1, Republican Party


Walt Minnick, U.S. Representative, ID-1, Democratic Party


Harry E. Mitchell, U.S. Representative, AZ-5, Democratic Party


Alan B. Mollohan, U.S. Representative, WV-1, Democratic Party


Dennis W. Moore, U.S. Representative, KS-3, Democratic Party


Gwendolynne S. Moore, U.S. Representative, WI-4, Democratic Party


James P. Moran, U.S. Representative, VA-8, Democratic Party


Jerry Moran, U.S. Representative, KS-1, Republican Party


Christopher S. Murphy, U.S. Representative, CT-5, Democratic Party


Patrick J. Murphy, U.S. Representative, PA-8, Democratic Party


Scott Murphy, U.S. Representative, NY-20, Democratic Party


Timothy F. Murphy, U.S. Representative, PA-18, Republican Party


John P. Murtha, U.S. Representative, PA-12, Democratic Party


Sue Wilkins Myrick, U.S. Representative, NC-9, Republican Party


Jerrold Nadler, U.S. Representative, NY-8, Democratic Party


Grace F. Napolitano, U.S. Representative, CA-38, Democratic Party


Richard E. Neal, U.S. Representative, MA-2, Democratic Party


Randy R. Neugebauer, U.S. Representative, TX-19, Republican Party


Eleanor Holmes Norton, Delegate to the U.S. House of Representatives, DC-1, Democratic Party


Devin G. Nunes, U.S. Representative, CA-21, Republican Party


Glenn Nye, U.S. Representative, VA-2, Democratic Party


James L. Oberstar, U.S. Representative, MN-8, Democratic Party


David R. Obey, U.S. Representative, WI-7, Democratic Party


Pete Olson, U.S. Representative, TX-22, Republican Party


John W. Olver, U.S. Representative, MA-1, Democratic Party


Solomon P. Ortiz, U.S. Representative, TX-27, Democratic Party


Bill Owens, U.S. Representative, NY-23, Democratic Party


Frank Pallone, U.S. Representative, NJ-6, Democratic Party


William J. Pascrell, U.S. Representative, NJ-8, Democratic Party


Ed Pastor, U.S. Representative, AZ-4, Democratic Party


Ron Paul, U.S. Representative, TX-14, Republican Party


Erik Paulsen, U.S. Representative, MN-3, Republican Party


Donald M. Payne, U.S. Representative, NJ-10, Democratic Party


Nancy Pelosi, U.S. Representative, CA-8, Democratic Party


Mike Pence, U.S. Representative, IN-6, Republican Party


Ed G. Perlmutter, U.S. Representative, CO-7, Democratic Party


Tom Perriello, U.S. Representative, VA-5, Democratic Party


Gary Peters, U.S. Representative, MI-9, Democratic Party


Collin C. Peterson, U.S. Representative, MN-7, Democratic Party


Thomas E. Petri, U.S. Representative, WI-6, Republican Party


Chellie Pingree, U.S. Representative, ME-1, Democratic Party


Joseph R. Pitts, U.S. Representative, PA-16, Republican Party


Todd Russell Platts, U.S. Representative, PA-19, Republican Party


Ted Poe, U.S. Representative, TX-2, Republican Party


Jared Polis, U.S. Representative, CO-2, Democratic Party


Earl Pomeroy, U.S. Representative, ND-1, Democratic Party


Bill Posey, U.S. Representative, FL-15, Republican Party


David E. Price, U.S. Representative, NC-4, Democratic Party


Tom Price, U.S. Representative, GA-6, Republican Party


Adam H. Putnam, U.S. Representative, FL-12, Republican Party


Mike Quigley, U.S. Representative, IL-5, Democratic Party


George P. Radanovich, U.S. Representative, CA-19, Republican Party


Nick J. Rahall, U.S. Representative, WV-3, Democratic Party


Charles B. Rangel, U.S. Representative, NY-15, Democratic Party


Dennis R. Rehberg, U.S. Representative, MT-1, Republican Party


Dave Reichert, U.S. Representative, WA-8, Republican Party


Silvestre Reyes, U.S. Representative, TX-16, Democratic Party


Laura Richardson, U.S. Representative, CA-37, Democratic Party


Ciro D. Rodriguez, U.S. Representative, TX-23, Democratic Party


Phil Roe, U.S. Representative, TN-1, Republican Party


Harold D. Rogers, U.S. Representative, KY-5, Republican Party


Mike D. Rogers, U.S. Representative, AL-3, Republican Party


Mike J. Rogers, U.S. Representative, MI-8, Republican Party


Dana Rohrabacher, U.S. Representative, CA-46, Republican Party


Tom Rooney, U.S. Representative, FL-16, Republican Party


Peter J. Roskam, U.S. Representative, IL-6, Republican Party


Ileana Ros-Lehtinen, U.S. Representative, FL-18, Republican Party


Mike A. Ross, U.S. Representative, AR-4, Democratic Party


Steven R. Rothman, U.S. Representative, NJ-9, Democratic Party


Lucille Roybal-Allard, U.S. Representative, CA-34, Democratic Party


Edward R. Royce, U.S. Representative, CA-40, Republican Party


C.A. Dutch Ruppersberger, U.S. Representative, MD-2, Democratic Party


Bobby L. Rush, U.S. Representative, IL-1, Democratic Party


Paul D. Ryan, U.S. Representative, WI-1, Republican Party


Timothy Ryan, U.S. Representative, OH-17, Democratic Party


John T. Salazar, U.S. Representative, CO-3, Democratic Party


Linda T. Sanchez, U.S. Representative, CA-39, Democratic Party


Loretta Sanchez, U.S. Representative, CA-47, Democratic Party


John Sarbanes, U.S. Representative, MD-3, Democratic Party


Stephen J. Scalise, U.S. Representative, LA-1, Republican Party


Jan D. Schakowsky, U.S. Representative, IL-9, Democratic Party


Mark Schauer, U.S. Representative, MI-7, Democratic Party


Adam B. Schiff, U.S. Representative, CA-29, Democratic Party


Jean Schmidt, U.S. Representative, OH-2, Republican Party


Aaron Schock, U.S. Representative, IL-18, Republican Party


Kurt Schrader, U.S. Representative, OR-5, Democratic Party


Allyson Schwartz, U.S. Representative, PA-13, Democratic Party


David Scott, U.S. Representative, GA-13, Democratic Party


Robert C. Scott, U.S. Representative, VA-3, Democratic Party


F. James Sensenbrenner, U.S. Representative, WI-5, Republican Party


Jose E. Serrano, U.S. Representative, NY-16, Democratic Party


Pete Sessions, U.S. Representative, TX-32, Republican Party


Joe Sestak, U.S. Representative, PA-7, Democratic Party


John B. Shadegg, U.S. Representative, AZ-3, Republican Party


Carol Shea-Porter, U.S. Representative, NH-1, Democratic Party


Brad J. Sherman, U.S. Representative, CA-27, Democratic Party


John M. Shimkus, U.S. Representative, IL-19, Republican Party


Heath Shuler, U.S. Representative, NC-11, Democratic Party


Bill Shuster, U.S. Representative, PA-9, Republican Party


Mike Simpson, U.S. Representative, ID-2, Republican Party


Albio Sires, U.S. Representative, NJ-13, Democratic Party


Ike Skelton, U.S. Representative, MO-4, Democratic Party


Louise McIntosh Slaughter, U.S. Representative, NY-28, Democratic Party


Adam Smith, U.S. Representative, WA-9, Democratic Party


Adrian M. Smith, U.S. Representative, NE-3, Republican Party


Christopher H. Smith, U.S. Representative, NJ-4, Republican Party


Lamar S. Smith, U.S. Representative, TX-21, Republican Party


Vic Snyder, U.S. Representative, AR-2, Democratic Party


Mark E. Souder, U.S. Representative, IN-3, Republican Party


Zack Space, U.S. Representative, OH-18, Democratic Party


Jackie Speier, U.S. Representative, CA-12, Democratic Party


John M. Spratt, U.S. Representative, SC-5, Democratic Party


Pete Stark, U.S. Representative, CA-13, Democratic Party


Cliff B. Stearns, U.S. Representative, FL-6, Republican Party


Bart T. Stupak, U.S. Representative, MI-1, Democratic Party


John Sullivan, U.S. Representative, OK-1, Republican Party


Betty Sutton, U.S. Representative, OH-13, Democratic Party


John S. Tanner, U.S. Representative, TN-8, Democratic Party


Gene Taylor, U.S. Representative, MS-4, Democratic Party


Harry Teague, U.S. Representative, NM-2, Democratic Party


Lee Terry, U.S. Representative, NE-2, Republican Party


Bennie G. Thompson, U.S. Representative, MS-2, Democratic Party


Glenn Thompson, U.S. Representative, PA-5, Republican Party


Mike Thompson, U.S. Representative, CA-1, Democratic Party


Mac Thornberry, U.S. Representative, TX-13, Republican Party


Todd Tiahrt, U.S. Representative, KS-4, Republican Party


Patrick J. Tiberi, U.S. Representative, OH-12, Republican Party


John F. Tierney, U.S. Representative, MA-6, Democratic Party


Dina Titus, U.S. Representative, NV-3, Democratic Party


Paul D. Tonko, U.S. Representative, NY-21, Democratic Party


Edolphus Towns, U.S. Representative, NY-10, Democratic Party


Niki Tsongas, U.S. Representative, MA-5, Democratic Party


Michael R. Turner, U.S. Representative, OH-3, Republican Party


Fred Upton, U.S. Representative, MI-6, Republican Party


null Vacant, U.S. Representative, FL-19,


Chris Van Hollen, U.S. Representative, MD-8, Democratic Party


Nydia M. Velazquez, U.S. Representative, NY-12, Democratic Party


Peter J. Visclosky, U.S. Representative, IN-1, Democratic Party


Greg Walden, U.S. Representative, OR-2, Republican Party


Tim Walz, U.S. Representative, MN-1, Democratic Party


Zach Wamp, U.S. Representative, TN-3, Republican Party


Debbie Wasserman Schultz, U.S. Representative, FL-20, Democratic Party


Maxine Waters, U.S. Representative, CA-35, Democratic Party


Diane E. Watson, U.S. Representative, CA-33, Democratic Party


Melvin Watt, U.S. Representative, NC-12, Democratic Party


Henry A. Waxman, U.S. Representative, CA-30, Democratic Party


Anthony Weiner, U.S. Representative, NY-9, Democratic Party


Peter F. Welch, U.S. Representative, VT-1, Democratic Party


Lynn A. Westmoreland, U.S. Representative, GA-3, Republican Party


Ed Whitfield, U.S. Representative, KY-1, Republican Party


Charlie Wilson, U.S. Representative, OH-6, Democratic Party


Joe Wilson, U.S. Representative, SC-2, Republican Party


Robert J. Wittman, U.S. Representative, VA-1, Republican Party


Frank R. Wolf, U.S. Representative, VA-10, Republican Party


Lynn C. Woolsey, U.S. Representative, CA-6, Democratic Party


David Wu, U.S. Representative, OR-1, Democratic Party


John Yarmuth, U.S. Representative, KY-3, Democratic Party


C.W. Young, U.S. Representative, FL-10, Republican Party


Donald Edward Young, U.S. Representative, AK-1, Republican Party


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